Kau Hospital

All Charges

Charge

Type

Setting

Price

SPONGE ENDO PEANUT

Facility

$88.00

Hospital Revenue Code	272
Min. Negotiated Rate	$27.28
Max. Negotiated Rate	$85.36
Rate for Payer: AlohaCare Medicaid	$44.00
Rate for Payer: AlohaCare Medicare	$27.28
Rate for Payer: Cash Price	$52.80
Rate for Payer: Devoted Health Medicare	$29.92
Rate for Payer: Hawaii Medical Service Association Medicare	$27.28
Rate for Payer: Hawaii Western Management Group Commercial	$83.60
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Humana Medicare	$27.28
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: Kaiser Permanente Medicaid	$44.88
Rate for Payer: Kaiser Permanente Medicare	$27.28
Rate for Payer: MDX Hawaii PPO	$85.36
Rate for Payer: Ohana Health Plan Medicaid	$27.28
Rate for Payer: Ohana Health Plan Medicare	$27.28
Rate for Payer: UnitedHealthcare Medicare	$27.28
Rate for Payer: University Health Alliance Commercial	$64.14

SPONGE NEURO .25X.25

Facility

$67.00

Hospital Revenue Code	272
Min. Negotiated Rate	$20.77
Max. Negotiated Rate	$64.99
Rate for Payer: AlohaCare Medicaid	$33.50
Rate for Payer: AlohaCare Medicare	$20.77
Rate for Payer: Cash Price	$40.20
Rate for Payer: Devoted Health Medicare	$22.78
Rate for Payer: Hawaii Medical Service Association Medicare	$20.77
Rate for Payer: Hawaii Western Management Group Commercial	$63.65
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Humana Medicare	$20.77
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: Kaiser Permanente Medicaid	$34.17
Rate for Payer: Kaiser Permanente Medicare	$20.77
Rate for Payer: MDX Hawaii PPO	$64.99
Rate for Payer: Ohana Health Plan Medicaid	$20.77
Rate for Payer: Ohana Health Plan Medicare	$20.77
Rate for Payer: UnitedHealthcare Medicare	$20.77
Rate for Payer: University Health Alliance Commercial	$48.84

SPONGE NEURO .25X.25

Facility

$67.00

Hospital Revenue Code	272
Min. Negotiated Rate	$56.95
Max. Negotiated Rate	$64.99
Rate for Payer: Cash Price	$40.20
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: MDX Hawaii PPO	$64.99

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$24,910.80

Service Code	MSDRG 537
Min. Negotiated Rate	$24,910.80
Max. Negotiated Rate	$24,910.80
Rate for Payer: Hawaii Medical Service Association Commercial	$24,910.80

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$24,910.80

Service Code	MSDRG 538
Min. Negotiated Rate	$24,910.80
Max. Negotiated Rate	$24,910.80
Rate for Payer: Hawaii Medical Service Association Commercial	$24,910.80

SPRAY SETS FOR TISSEEL/ARTISS

Facility

$259.00

Hospital Revenue Code	272
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$155.40
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: MDX Hawaii PPO	$251.23

SPRAY SETS FOR TISSEEL/ARTISS

Facility

$259.00

Hospital Revenue Code	272
Min. Negotiated Rate	$80.29
Max. Negotiated Rate	$251.23
Rate for Payer: AlohaCare Medicaid	$129.50
Rate for Payer: AlohaCare Medicare	$80.29
Rate for Payer: Cash Price	$155.40
Rate for Payer: Devoted Health Medicare	$88.06
Rate for Payer: Hawaii Medical Service Association Medicare	$80.29
Rate for Payer: Hawaii Western Management Group Commercial	$246.05
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Humana Medicare	$80.29
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: Kaiser Permanente Medicaid	$132.09
Rate for Payer: Kaiser Permanente Medicare	$80.29
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: Ohana Health Plan Medicaid	$80.29
Rate for Payer: Ohana Health Plan Medicare	$80.29
Rate for Payer: UnitedHealthcare Medicare	$80.29
Rate for Payer: University Health Alliance Commercial	$188.79

SROM MODULAR HIP SYS 55-0534

Facility

$4,310.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,413.60
Max. Negotiated Rate	$4,180.70
Rate for Payer: Cash Price	$2,586.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,017.00
Rate for Payer: Health Management Network Commercial	$3,663.50
Rate for Payer: Kaiser Permanente Commercial	$3,879.00
Rate for Payer: MDX Hawaii PPO	$4,180.70
Rate for Payer: University Health Alliance Commercial	$2,413.60

SROM MODULAR HIP SYS 55-0534

Facility

$4,310.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,336.10
Max. Negotiated Rate	$4,180.70
Rate for Payer: AlohaCare Medicaid	$2,155.00
Rate for Payer: AlohaCare Medicare	$1,336.10
Rate for Payer: Cash Price	$2,586.00
Rate for Payer: Devoted Health Medicare	$1,465.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,336.10
Rate for Payer: Hawaii Western Management Group Commercial	$3,017.00
Rate for Payer: Health Management Network Commercial	$3,663.50
Rate for Payer: Humana Medicare	$1,336.10
Rate for Payer: Kaiser Permanente Commercial	$3,879.00
Rate for Payer: Kaiser Permanente Medicaid	$2,198.10
Rate for Payer: Kaiser Permanente Medicare	$1,336.10
Rate for Payer: MDX Hawaii PPO	$4,180.70
Rate for Payer: Ohana Health Plan Medicaid	$1,336.10
Rate for Payer: Ohana Health Plan Medicare	$1,336.10
Rate for Payer: UnitedHealthcare Medicare	$1,336.10
Rate for Payer: University Health Alliance Commercial	$2,413.60

SROM TOTAL HIP SYS 52.3420

Facility

$8,873.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,750.63
Max. Negotiated Rate	$8,606.81
Rate for Payer: AlohaCare Medicaid	$4,436.50
Rate for Payer: AlohaCare Medicare	$2,750.63
Rate for Payer: Cash Price	$5,323.80
Rate for Payer: Devoted Health Medicare	$3,016.82
Rate for Payer: Hawaii Medical Service Association Medicare	$2,750.63
Rate for Payer: Hawaii Western Management Group Commercial	$6,211.10
Rate for Payer: Health Management Network Commercial	$7,542.05
Rate for Payer: Humana Medicare	$2,750.63
Rate for Payer: Kaiser Permanente Commercial	$7,985.70
Rate for Payer: Kaiser Permanente Medicaid	$4,525.23
Rate for Payer: Kaiser Permanente Medicare	$2,750.63
Rate for Payer: MDX Hawaii PPO	$8,606.81
Rate for Payer: Ohana Health Plan Medicaid	$2,750.63
Rate for Payer: Ohana Health Plan Medicare	$2,750.63
Rate for Payer: UnitedHealthcare Medicare	$2,750.63
Rate for Payer: University Health Alliance Commercial	$4,968.88

SROM TOTAL HIP SYS 52.3420

Facility

$8,873.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,968.88
Max. Negotiated Rate	$8,606.81
Rate for Payer: Cash Price	$5,323.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,211.10
Rate for Payer: Health Management Network Commercial	$7,542.05
Rate for Payer: Kaiser Permanente Commercial	$7,985.70
Rate for Payer: MDX Hawaii PPO	$8,606.81
Rate for Payer: University Health Alliance Commercial	$4,968.88

SSPC NXT 2.5 DELIVERY CATH 9F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$537.23
Max. Negotiated Rate	$1,681.01
Rate for Payer: AlohaCare Medicaid	$866.50
Rate for Payer: AlohaCare Medicare	$537.23
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Devoted Health Medicare	$589.22
Rate for Payer: Hawaii Medical Service Association Medicare	$537.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,646.35
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Humana Medicare	$537.23
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: Kaiser Permanente Medicare	$537.23
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: Ohana Health Plan Medicaid	$537.23
Rate for Payer: Ohana Health Plan Medicare	$537.23
Rate for Payer: UnitedHealthcare Medicare	$537.23
Rate for Payer: University Health Alliance Commercial	$1,263.18

SSPC NXT 2.5 DELIVERY CATH 9F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,473.05
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: MDX Hawaii PPO	$1,681.01

SSPC NXT Y DELIVERY CATH

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,473.05
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: MDX Hawaii PPO	$1,681.01

SSPC NXT Y DELIVERY CATH

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$537.23
Max. Negotiated Rate	$1,681.01
Rate for Payer: AlohaCare Medicaid	$866.50
Rate for Payer: AlohaCare Medicare	$537.23
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Devoted Health Medicare	$589.22
Rate for Payer: Hawaii Medical Service Association Medicare	$537.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,646.35
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Humana Medicare	$537.23
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: Kaiser Permanente Medicaid	$883.83
Rate for Payer: Kaiser Permanente Medicare	$537.23
Rate for Payer: MDX Hawaii PPO	$1,681.01
Rate for Payer: Ohana Health Plan Medicaid	$537.23
Rate for Payer: Ohana Health Plan Medicare	$537.23
Rate for Payer: UnitedHealthcare Medicare	$537.23
Rate for Payer: University Health Alliance Commercial	$1,263.18

STABILIZER FEMORAL 5512-F-201

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,878.48
Max. Negotiated Rate	$11,914.51
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Kaiser Permanente Commercial	$11,054.70
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: University Health Alliance Commercial	$6,878.48

STABILIZER FEMORAL 5512-F-201

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,807.73
Max. Negotiated Rate	$11,914.51
Rate for Payer: AlohaCare Medicaid	$6,141.50
Rate for Payer: AlohaCare Medicare	$3,807.73
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Devoted Health Medicare	$4,176.22
Rate for Payer: Hawaii Medical Service Association Medicare	$3,807.73
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Humana Medicare	$3,807.73
Rate for Payer: Kaiser Permanente Commercial	$11,054.70
Rate for Payer: Kaiser Permanente Medicaid	$6,264.33
Rate for Payer: Kaiser Permanente Medicare	$3,807.73
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: Ohana Health Plan Medicaid	$3,807.73
Rate for Payer: Ohana Health Plan Medicare	$3,807.73
Rate for Payer: UnitedHealthcare Medicare	$3,807.73
Rate for Payer: University Health Alliance Commercial	$6,878.48

STABILIZER FEMORAL 5512-F-502

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,878.48
Max. Negotiated Rate	$11,914.51
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Kaiser Permanente Commercial	$11,054.70
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: University Health Alliance Commercial	$6,878.48

STABILIZER FEMORAL 5512-F-502

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,807.73
Max. Negotiated Rate	$11,914.51
Rate for Payer: AlohaCare Medicaid	$6,141.50
Rate for Payer: AlohaCare Medicare	$3,807.73
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Devoted Health Medicare	$4,176.22
Rate for Payer: Hawaii Medical Service Association Medicare	$3,807.73
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Humana Medicare	$3,807.73
Rate for Payer: Kaiser Permanente Commercial	$11,054.70
Rate for Payer: Kaiser Permanente Medicaid	$6,264.33
Rate for Payer: Kaiser Permanente Medicare	$3,807.73
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: Ohana Health Plan Medicaid	$3,807.73
Rate for Payer: Ohana Health Plan Medicare	$3,807.73
Rate for Payer: UnitedHealthcare Medicare	$3,807.73
Rate for Payer: University Health Alliance Commercial	$6,878.48

STABILIZER FEMORAL 5515-F-302

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,327.42
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$1,327.42
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$1,455.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,327.42
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$1,327.42
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$1,327.42
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$1,327.42
Rate for Payer: Ohana Health Plan Medicare	$1,327.42
Rate for Payer: UnitedHealthcare Medicare	$1,327.42
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER FEMORAL 5515-F-302

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER INSERT 5537-G-113

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,519.93
Max. Negotiated Rate	$4,755.91
Rate for Payer: AlohaCare Medicaid	$2,451.50
Rate for Payer: AlohaCare Medicare	$1,519.93
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Devoted Health Medicare	$1,667.02
Rate for Payer: Hawaii Medical Service Association Medicare	$1,519.93
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Humana Medicare	$1,519.93
Rate for Payer: Kaiser Permanente Commercial	$4,412.70
Rate for Payer: Kaiser Permanente Medicaid	$2,500.53
Rate for Payer: Kaiser Permanente Medicare	$1,519.93
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: Ohana Health Plan Medicaid	$1,519.93
Rate for Payer: Ohana Health Plan Medicare	$1,519.93
Rate for Payer: UnitedHealthcare Medicare	$1,519.93
Rate for Payer: University Health Alliance Commercial	$2,745.68

STABILIZER INSERT 5537-G-113

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,745.68
Max. Negotiated Rate	$4,755.91
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Kaiser Permanente Commercial	$4,412.70
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: University Health Alliance Commercial	$2,745.68

STABILIZER POST SZ8 5515-F-802

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,327.42
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$1,327.42
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$1,455.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,327.42
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$1,327.42
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$1,327.42
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$1,327.42
Rate for Payer: Ohana Health Plan Medicare	$1,327.42
Rate for Payer: UnitedHealthcare Medicare	$1,327.42
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER POST SZ8 5515-F-802

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

Know your out-of-pocket cost for care.

All Charges